The Importance of Posture (Upper Cross Syndrome)

Posture – it is part of the first impression that you make to the outside world and it says so much about how you feel about yourself. Poor posture is highly prevalent in our society and one of the most common incorrect postures you will see if you start checking people out (or look in the mirror), is this –

Anterior Head Carriage

Now this famous woman is a perfect example of someone who carries her head before her body, also known as anterior head carriage. Many people walk around like this; it’s as if they are already somewhere else or trying to be, never actually present.

Ideally, a person’s ear should be in line with their shoulder and their shoulder should be in line with their hip. For every inch the head is forward from its natural position, it is twice as heavy and heads are really heavy to start with. This results in muscle imbalances as they strain to keep the head in position. In this posture, because the head is anterior, it naturally tilts forward resulting in the small muscles at the base of the neck, called the sub-occipitals to tighten, to enable the head to tilt up so that the person can see around them.

Upper Cross Syndrome

This is a further photo of the same woman showing another posture that commonly goes with anterior head carriage; here, unfortunately, she looks rather glamorous but the reality is her shoulders are forward and her scapula (shoulder blades) are winging (sticking out). This is due to hypertonic (too strong) muscles of the chest and hypotonic (weak) muscles of the back. This posture was first named by Dr. Vladimir Janda, a Czech neurologist and physiatrist, as Upper Cross Syndrome.

Janda’s approach is based on the function of the body rather than just the structure. Through observation and electromyography tests he concluded it was not just the strength of the muscle that was important but the sequence of the firing of muscle contraction, therefore an interdependence of the musculoskeletal and central nervous system, termed the ‘sensorimotor’ system, or lack of it, that was of great relevance and could predict injury patterns of a patient. Changes within one part of the system are reflected by compensations elsewhere within the system as the body tries to reach equilibrium (you’ve probably heard me say this one way or another, many times as I work on you). Janda noted that these changes in muscular tone create muscle imbalance, which leads to movement dysfunction that can result in pain elsewhere in the body and possible degeneration (wear and tear) of joints. Therefore, it is important to determine the cause of pain rather than just treat where it hurts.

I don’t want to bore you by getting into too much detail so hang in there, this is worth knowing.

The human body can reasonably be divided into two muscle type groups, Tonic and Phasic. The Tonic muscle group is made up of flexor muscles and this group is phylogenetically older and more dominant than the Phasic muscles. The Phasic group are extensor muscles that emerge shortly after birth and activate to resist the forces of gravity. Due to the dominance of the flexor muscles, they tend to tighten becoming shorter, whereas the extensor muscles are flaccid and therefore are weaker and have less tone. This can be observed when there is neurological damage e.g. a person with cerebral palsy or a cerebrovascular accident (stoke), the more dominant flexor muscles go into spasm producing a spastic posture.

Here is a table of Tonic and Phasic muscles.

Tonic muscles

Phasic muscles

Upper limb flexorsStenocleidomastoid

Scalenes

Levator Scapulae

Upper Trapezius

Pectoralis major

Upper limb extensorsDeep neck flexors

Rhomboids

Serratus Anterior

Lower Trapezius

Now what this all really means is – many people have incorrect muscle patterns resulting in a combination of tight and weak muscles and commonly, in the upper body, the pattern of imbalance looks like this (I think a picture always helps):

Now you know what I’m talking about, don’t you? So what can be done about it?

Well, Janda determined that a tight, shortened muscle can inhibit its opposing muscle e.g. tight pectoral muscles will result in a weak serratus anterior muscle. And the good news; Janda also determined that many times just stretching the tight muscle allows the opposing muscle to function better. Therefore, the first step to counter Upper Cross Syndrome is to stretch the pectoral muscles.

Pectoralis stretch – In this video, Rich is demonstrating just that!

Now how to strengthen the weak extensor muscles-:

Deep neck flexors – by doing this exercise, you are also stretching the tight sub-occipital muscles.

Wall Angel – stand with your back against a wall and your feet a shoes length away from the skirting board. Keep your spine, including your neck, against the wall. To do this you need to keep the ribcage/diaphragm down by activating the abdominal muscles and not let the ribcage lift as you put your arms into position. Many people can’t get into position, let alone do the exercise. Don’t give up, just keep doing it and you will improve. Here is Elke demonstrating the exercise.

Holding a Platter 1–for those thatfind the Wall Angel too difficult at first, try this is exercise and then progress to the one below.

Holding a Platter 2– once you can do this exercise well then progress to the Wall Angel.

Prone Angel – here Rich is demonstrating another way of doing the Wall Angel for those people that find it hard to get into Wall Angel position (but don’t give up on Wall Angel).

The Y exercise– it is important with this exercise not to lift your shoulders to your ears as you stretch out your arms. Don’t activate the Upper Trapezius muscles; keep those shoulders down. Here is Elke showing us how to do it.

Serratus Anterior– this is a difficult exercise to do correctly but it’s really important as the weakness of this muscle is usually the foundation of most shoulder problems. The biggest mistake people make is they just move their shoulder blades together and apart but the exercise is about moving the blades down and to the side. (It’s also difficult to explain) Here it is demonstrated really well by Rich.

New Addition– this is the latest video addition for the Serratus Anterior – think you may find it easier to understand, feel and do.

Brugger Exercise– this exercise can be done either sitting or standing (please follow this link for the whole story)

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8 comments

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[…] suffer with hypertonic (too tight) pectoral muscles that bring our shoulders forward and rounded (Upper Cross Syndrome). The following video demonstrates a lovely way to open the chest and stretch those over worked […]

Hi, great instructions/videos, and I would like to give these exercises a try as I have upper crossed syndrome. After watching the videos, there are a couple of things missing though: Rep/hold count for each exercise plus number of sets and exercise frequency. Could you enlighten us on these, please? Thanks so much.

Hi CS – we use these videos for our patients and tell them at the time the amount of reps etc we want each individual to do, as everyone is starting from their own place. Without know your knowing your fitness level, I would probably suggest: start reps of 5 or 10 and sets of 3; if doing a stretch then hold for 20 to 30 secs. It is much more important to do an exercise correctly and do less than it is to do it incorrectly but many more.
Hope this helps.
Anne